| NPI | 1346351624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8630) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4547) |
| 1223G0001X Dentist, General Practice (Licence: NM DD3644) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-02-15 |